Many business-specific requirements under the health care law are still being modified, but most have been defined. Learn which requirements affect your business and what you have to do to comply.
changes to the administration of health plans
New administrative changes that were rolled out in 2014 include the following:
Provisions of grandfathering will be made clear.
To maintain grandfathered status, the insurers or group health plans must include a statement in any materials provided to enrollees describing the policy that is grandfathered.
A Summary of Benefits and Coverage is mandatory.
Effective September 23, 2012, self-insured plan sponsors and insurers must provide participants at initial and annual enrollment with a uniform Summary of Benefits and Coverage (SBC) explanation that includes standardized information. Learn more about SBC Requirements.
Coverage reporting became mandatory in 2013.
Effective January 2014 (for tax year 2013) employers with more than 250 W-2 forms must annually report to the federal government whether they offer health coverage to their full-time employees and dependents, the total number and names of full-time employees receiving health coverage, the length of any waiting period and other information about the plan’s cost. Reporting this information is currently optional for smaller employers filing fewer than 250 W-2 forms until further guidance is issued.
Flexible Savings Accounts (FSAs), Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) are being reduced.
Effective Jan. 1, 2011, reimbursements from FSAs, HRAs and HSAs are available only for insulin and for prescribed medicine or drugs. FSA, HRA or HSA dollars may still be used for over-the-counter medicines if they are prescribed. Effective Jan. 1, 2013, annual contributions to FSAs are limited to $2,500 and the penalty for withdrawing HSA funds for non-medical expenses increased by 20 percent.
Employers are responsible for giving more notice to employees.
Effective October 1, 2013, employers must provide employees written notice of:
Potential eligibility for federal assistance if the health plan offered by your business is “unaffordable” based on criteria under the health care law and if the employee household income is below certain thresholds.
Possible loss of employer contribution to health coverage if employees choose to purchase health insurance through Covered California’s Individual Marketplace.
new protection from discrimination for employees
Effective March 23, 2010, employers are prohibited from discharging or discriminating against any employee for receiving a federal tax credit or cost-sharing subsidy to purchase health insurance.
Since 2010, employers must provide a reasonable break each time the employee needs to express milk for up to one year after the birth of her child. Employers must provide nursing mothers a place to express milk – other than a bathroom – that is shielded from view and free from intrusion from coworkers and the public.
new incentives for employer responsibility take effect beginning in 2015
The health care law does not require employers to provide health insurance for their employees. However, employers with 50 to 99 or more full-time employees that do not offer insurance or offer insurance that is unaffordable will be subject to fees beginning January 1, 2016. Beginning January 1, 2015, those with 100 or more full time equivalent employees will now face fees if they do not offer coverage to at least 70 percent of their full time workforce.
Since 2014, employers with more than 200 full-time equivalent employees that offer health coverage are required to automatically enroll new full-time employees in the plan. An employee may opt out of coverage.